What follows is the prognosis for Chronic Renal Failure based on hospice admission criteria. If a patient meets these criteria he or she is eligible for hospice care which means that he or she has an estimated six months or less to live.
To meet the CMS Disease Specific Criteria For terminal (6 months or less prognosis for) Chronic Renal Failure, the patient must meet the following:
A patient is eligible for hospice services if he meets these three criteria:
1) has a Palliative Performance Scale of less than 70% [Resource (2)]
2) is dependent on at least two Activities of Daily Living [Resource (3), and
3) meets the Disease Specific Guideline for Chronic Renal Failure [Resource (1)]Chronic Kidney Disease
(1 and either 2, 3 or 4 should be present. Factors from 5
will lend supporting documentation.)1. The patient isn’t seeking dialysis or renal transplant, or
is discontinuing dialysis. As with any other condition, an
individual with renal disease is eligible for the Hospice
Benefit if he has a prognosis of six months or less, if the
illness runs its normal course. No regulation precludes
patients on dialysis from electing hospice. However, the
continuation of dialysis significantly alters a patient’s
prognosis, and thus may impact that individual’s eligibility.When an individual elects hospice care for end stage
renal disease (ESRD) or for a condition to which the need
for dialysis is related, the hospice agency is financially
responsible for the dialysis. In such cases, there is no
additional reimbursement beyond the per diem rate. The
only situation in which a beneficiary may access both the
Hospice Benefit and the ESRD benefit is when the need for
dialysis is not related to the patient’s terminal illness.2. Creatinine clearance <10 cc/min (<15 cc/min for diabetics); or <15cc/min (<20cc/min for diabetics) with comorbidity of congestive heart failure.
3. Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetics).
4. Signs and symptoms of renal failure: a. Uremia; b. Oliguria (<400 cc/24 hours); c. Intractable hyperkalemia (>7.0) not responsive to treatment; d. Uremic pericarditis; e. Hepatorenal syndrome; f. Intractable fluid overload, not responsive to treatment.
5. Estimated glomerular filtration rate (GFR) <10 ml/min.
Resources:
1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014
2. The Palliative Performance Scale For Determination Of Hospice Eligibility
Posted on March 29, 2018 by Tom Wade MD
3. Instruments For The Assessment Of The Activities Of Daily Living [ADLs]
Posted on March 30, 2018 by Tom Wade MD
